CHAPTER 43 – PERSONAL HEALTH
SUBCHAPTER 43K – NEWBORN SCREENING FOR CRITICAL CONGENITAL HEART DEFECTS
10A NCAC 43K .0101 DEFINITIONS
As used in this Section:
(1)
"Neonate" means any term infant less than 28 days of age or any preterm infant less than 28 days
corrected age.
(2)
"Infant" means a person who is less than 365 days of age.
(3)
"Critical congenital heart defects" (CCHD) means heart conditions present at birth that are
dependent on therapy to maintain patency of the ductus arteriosus for either adequate pulmonary
or systemic blood flow and that require catheter or surgical intervention in the first year of life.
Critical congenital heart defects are associated with significant morbidity and mortality and may
include hypoplastic left heart syndrome, pulmonary atresia, tetralogy of Fallot, total anomalous
pulmonary venous return, transposition of the great arteries, tricuspid atresia, and truncus
arteriosus.
(4)
"Medical facility" means a free-standing birthing center, licensed hospital, or licensed ambulatory
surgery center where scheduled or emergency births occur or where inpatient neonatal services are
provided.
(5)
"Pulse oximetry" means a non-invasive transcutaneous assessment of arterial oxygen saturation
using near infrared spectroscopy. This screening test measures with high reliability and validity
the percentage of hemoglobin that is oxygenated, also known as the blood oxygen saturation.
(6)
"Positive screening" means the final result is a failed or abnormal pulse oximetry screening for
critical congenital heart defects for a neonate or infant using a screening protocol based on the
most current American Academy of Pediatrics and American Heart Association (AAP/AHA)
recommendations. This includes neonates or infants who have not yet been confirmed to have
critical congenital heart defects or have other conditions to explain abnormal pulse oximetry
results. A copy of the recommendations is available for inspection at the NC Division of Public
Health, Women's and Children's Health Section, Children and Youth Branch, 5601 Six Forks
Road, Raleigh, NC 27609. In addition, the recommendations can be accessed at the American
Academy
of
Pediatrics
website
at:
http://pediatrics.aappublications.org/content/128/5/e1259.full.pdf+html?sid=85e81711-f9b8-43d1a352-479168895a72.
(7)
"Negative screening" means the final result is a passed or normal pulse oximetry screening for
critical congenital heart defects for a neonate or infant using a screening protocol based on the
most current AAP/AHA recommendations.
(8)
"Attending providers of the neonate or infant" means the health care providers, such as
pediatricians, family physicians, physician assistants, midwives, nurse practitioners,
neonatologists, and other specialty physicians, who perform neonatal and infant assessments and
review positive and negative pulse oximetry screening results to perform an evaluation and to
create a plan of care for the neonate or infant prior to discharge from the care of the health care
provider. This includes health care providers who attend to neonates or infants in hospitals, freestanding birthing centers, homes, or other locations.
History Note:
Authority G.S. 130A-125;
Temporary Adoption Eff. July 25, 2014;
Eff. April 1, 2015.
10A NCAC 43K .0102 SCREENING REQUIREMENTS
(a) All medical facilities and attending providers of a neonate or infant shall assure the following:
(1)
Screening of every neonate for critical congenital heart defects (CCHD) using pulse oximetry shall
be performed at 24 to 48 hours of age using a written protocol developed by the provider based
upon and in accordance with the most current recommendations from the American Academy of
Pediatrics and American Heart Association (AAP/AHA) which are incorporated by reference
including subsequent amendments and editions, unless a diagnostic neonatal echocardiogram has
been performed. A copy of the recommendations is available for inspection at the NC Division of
Public Health, Women's and Children's Health Section, Children and Youth Branch, 5601 Six
Forks Road, Raleigh, NC 27609. In addition, the recommendations can be accessed at the
American Academy of Pediatrics website at:
http://pediatrics.aappublications.org/content/128/5/e1259.full.pdf+html?sid=85e81711-f9b8-43d1a352-479168895a72.
(2)
Screening of a neonate for CCHD who is born in a free-standing birthing center or home may
occur as early as 6 hours of age but shall not occur later than 48 hours of age using the AAP/AHA
recommendations.
(3)
Screening of neonates and infants in neonatal intensive care units for critical congenital heart
defects using pulse oximetry screening shall be performed using a written protocol based on the
AAP/AHA recommendations as soon as the neonate or infant is stable, as determined by the
attending provider, and off oxygen and before discharge unless a diagnostic echocardiogram is
performed on the neonate or infant after birth and prior to discharge from the medical facility.
(4)
Only U.S. Food and Drug Administration approved pulse oximetry equipment is used and
maintained to screen the neonate or infant for the presence of critical congenital heart defects.
(b) Parents or guardians may object to the critical congenital heart defects screening at any time before the
screening is performed in accordance with G.S. 130A-125.
(c) All medical facilities and attending providers of the neonate or infant shall have and implement a written
protocol developed by the provider for evaluation and follow up of positive critical congenital heart defect
screenings.
(1)
Evaluation and follow up of a positive screening for all neonates shall occur as soon as possible
but no later than 24 hours of obtaining a positive screening result. Evaluation and follow-up shall
be in accordance with the most current published recommendations from the American Academy
of Pediatrics and American Heart Association (AAP/AHA) which is incorporated by reference
including subsequent amendments and editions. A copy of the recommendations is available for
inspection at the NC Division of Public Health, Women's and Children's Health Section, Children
and Youth Branch, 5601 Six Forks Road, Raleigh, NC 27609. In addition, the recommendations
can be accessed at the American Academy of Pediatrics website at:
http://pediatrics.aappublications.org/content/128/5/e1259.full.pdf+html?sid=85e81711-f9b8-43d1a352-479168895a72.
(2)
Attending providers of neonates and infants in neonatal intensive care units must have a written
protocol developed by the provider for evaluation and follow up of positive screenings in place at
their medical facility.
(3)
Options for neonatal or infant echocardiograms may include on-site, telemedicine, or by transfer
or referral to an appropriate medical facility with the capacity to perform and interpret a neonatal
or infant echocardiogram. Echocardiograms must be interpreted as recommended by the most
current recommendations from the AAP/AHA, which are incorporated by reference including
subsequent amendments and editions. A copy of the recommendations is available for inspection
at the NC Division of Public Health, Women's and Children's Health Section, Children and Youth
Branch, 5601 Six Forks Road, Raleigh, NC 27609. In addition, the recommendations can be
accessed at the American Academy of Pediatrics website at:
http://pediatrics.aappublications.org/content/128/5/e1259.full.pdf+html?sid=85e81711-f9b8-43d1a352-479168895a72.
History Note:
Authority G.S. 130A-125;
Temporary Adoption Eff. July 25, 2014;
Eff. April 1, 2015.
10A NCAC 43K .0103 REPORTING REQUIREMENTS
(a) All medical facilities and attending providers of neonates or infants performing critical congenital heart defect
(CCHD) screening shall report the information described below about positive screenings to a statewide CCHD
database maintained by the Perinatal Quality Collaborative of North Carolina (PQCNC). The following information
must be reported by medical facilities and attending providers within 7 days of all positive screenings:
(1)
date and time of birth of the neonate or infant, gestational age, and the medical facility or birth
location, and
(2)
age in hours at time of screening; all pulse oximetry saturation values, including initial,
subsequent, and final screening results; final diagnosis if known; any known interventions and
treatment, and any need for transport or transfer; and the location of the transfer or transport if
known.
(b) Within two weeks of receiving a positive screening, PQCNC shall report the above information from the CCHD
database to the NC Birth Defects Monitoring Program using a unique identifier generated by the CCHD database for
the neonate or infant. The unique identifier shall be retained by the source medical facility or attending provider for
help with identification of the neonate or infant.
(c) All medical facilities and attending providers of neonates or infants performing critical congenital heart defect
screening shall report aggregate information described in Subparagraphs (e)(1) through (e)(7) of this Rule quarterly
and no later than 15 days after the end of each quarter of the state fiscal year to a statewide CCHD database
maintained by the Perinatal Quality Collaborative of North Carolina (PQCNC).
(d) PQCNC shall report the aggregate information described in Sub-paragraphs (e)(1) through (e)(7) to the NC
Birth Defects Monitoring Program within 30 days after the end of each quarter of the state fiscal year.
(e) The required quarterly aggregate information from medical facilities and attending providers of neonates or
infants reported to PQCNC and that PQCNC reports to the NC Birth Defects Monitoring Program shall include the
total unduplicated counts of:
(1)
live births;
(2)
neonates and infants who were screened;
(3)
negative screenings;
(4)
positive screenings;
(5)
neonates or infants whose parents or guardians objected to the critical congenital heart defect
screenings;
(6)
transfers into the medical facility, not previously screened; and
(7)
neonates and infants not screened and the reasons if known which include a diagnostic
echocardiogram being performed after birth and prior to discharge, transfer out of the medical
facility before screening, or death .
History Note:
Authority G.S. 130A-125;
Temporary Adoption Eff. July 25, 2014;
Eff. April 1, 2015.